Many inner-city youth with challenging behavioral problems and their families experience extremely stressful circumstances related to poverty, under-resourced schools, substance abuse, lack of access to child mental health clinics, exposure to health epidemics, and community violence (Harrison et al, 2004;McKay &Bannon, 2004;Monuteaux, 2007). Nationwide, conduct difficulties account for 1/3 to 1/2 of all youth mental health referrals, with rates being even higher in children within urban communities (Frick, 1998;Loeber et al., 2000;Tolan et al., 1998). Therefore, the development of efficient and effective mental health services options for urban, low-income families with children displaying conduct difficulties is a national priority. Guided by Olin et al.'s (2010) adaptation of United Theory of Behavior (Jaccard et al 1999, 2002;Olin, 2010), a mixed-method research strategy will be utilized to explore possible adaptations to the empirically-based Multiple Family Group (MFG;McKay et al., 2004;2010) service delivery as a potential alternative child mental health services approach for families who experience extreme psychosocial stressors. Study #1 will gather qualitative data from adult caregivers of inner-city youth (who report high levels of familial and psychosocial stress at baseline of the Parent Study) regarding factors that influence their involvement in the MFG service delivery model, as well as recommendations for improving the MFG service delivery model. Study #2 will involve a secondary analysis of the complete MFG dataset (available in 2011), assessing the effects of engagement as a mediator of multi-level stressors and child outcomes, service delivery, and family-level outcomes. Three separate hypotheses will be tested to explore the relationship between engagement in MFGs and multi-level stressors on family-level outcomes, child-level outcomes, and process characteristics of service delivery. PUBLIC HEALTH RELEVANCE: The current application proposes two studies that examine how family functioning and outcomes for highly stressed families are affected by the Multiple Family Group (MFG) service delivery, which is designed to engage families, increase child mental health service use and to reduce disruptive behavior disorders in urban, low-income children of color (Franco et al., 2008;Gopalan &Franco, 2009;McKay, et al., 1995;1999;2002;2009;2010;Stone, McKay, &Stoops, 1996). Qualitative and quantitative techniques will be used to help understand where modifications, if any, may be needed to adapt the MFG intervention to most effectively address issues around family-level engagement and child behavioral outcomes for families living within of extremely stressful circumstances, such as poverty, under-resourced schools, substance abuse, lack of child mental health clinics, exposure to various health epidemics, and community violence (Parkerson et al, 1995;Harrison et al, 2004;McKay &Bannon, 2004). Given current knowledge of the effects of various stressors on family outcomes (Franco, et al., 2010;Kruger et al, 2007;Kotchick et al., 2005;Lin et al., 2009;Gutman et al., 2005;Felner et al, 1995), developing an effective, engaging, and innovative community-based mental health service for families will help families access and benefit from much needed treatment.